The BadgerCare Plus Basic Plan legislation came before the Legislature’s Joint Committee on Finance Tuesday morning, where it ultimately passed the bill with a 12-4 vote along partisan lines.

This new bill was proposed in response to a flood of 25,000 people added to the BadgerCare Plus Core Plan waiting list after the program was closed in 2006 due to over-enrollment.

These two plans — the Core and Basic plan — are both part of Gov. Jim Doyle‘s goal of ensuring 98 percent of Wisconsin residents have access to health care.

BadgerCare Plus Core Plan

The Core plan was created in conjunction with the 2008 expansion of the BadgerCare public health system.

According to Department of Health Services spokesperson Stephanie Smiley, Core was specifically designed to cover those who had typically not been eligible for insurance by the state government, specifically those who have been without health insurance for 12 months — with some exceptions as loss of job or health care through no fault of their own — and for adults without dependent children.

The Core plans cover a variety of services including chiropractic services; disposable medical supplies; doctor visits; hospice and hospital services; emergency services such as visits, ambulance rides and dental; some prescription drugs; physical, occupational and speech therapy; and podiatry.

Some of the major services not covered in the plan include non-emergency dental, hearing services, routine vision exams, inpatient mental health and substance abuse treatment, non-emergency transportation, nursing home care, reproductive health services — covered by another BadgerCare plan, Family Planning — and services for children and pregnant women.

The plan costs $60, which is an enrollment fee paid each year when the resident applies or reapplies for the program, along with low-cost co-payments for some services. The cost of the co-payments varies between two groups: those above 100 percent of the federal poverty line and those between 100 and 200 percent of the federal poverty line.

Aside from this revenue stream, Smiley said Core is funded by federal money to be used for county level insurance, state funding and hospital assessments — where the state assesses hospital fees, which are matched by the federal government to be used for services.

Applications for the Core plan opened in June 2009, after which DHS received an “onslaught”

of applications and had to suspend enrollment only a few months later in October, Smiley said.

DHS then opened up a waiting list for those still wishing to apply for the Core plan so people could be accepted as soon as spots and funding were available.

BadgerCare Plus Basic Plan

The Basic plan was proposed by Doyle in 2009 after the waiting list for Core became too long due to the ailing economy.

As a solution to the problem, Doyle proposed another health care option which is a temporary, bare-bones health care plan only available to those on the Core waiting list.

“The best way to describe it is as BadgerCare Plus CORE Plan LITE, the diet version of the Core plan,” Smiley said. “It is a much more limited benefit than the Core plan.”

The Basic plan would provide very limited services, including: 10 doctor visits; limited prescription drugs; one inpatient hospital stay and five outpatient visits; five emergency room visits; 10 physical, occupational or speech therapy visits; emergency dental services; limited disposable medical supplies, such as syringes or diabetic pens; emergency ambulance rides; chiropractic services; and laboratory and radiology diagnostic services.

The plan would be self-funded, with premiums covering the cost of the entire program, Smiley said. Members would pay a $130 monthly premium per person for these limited services as well as much larger premiums if they exceed those services provided under the original cost.

Should the cost of the program outweigh the revenue intake, DHS has also set aside $1 million in a contingency fund from federal money. Other options to fix the problem if it occurs would be to increase the fee or decrease the benefit package.

JCF gives legislation the okay

The bill met some criticism by some Republican legislators who were not happy the Basic plan is not required to follow the same insurance mandates as private sector insurance companies.

“This is a policy that is not a panacea; it’s what happened when you have the government dictating different terms than what they give the private sector,” said Rep. Robin Vos, R-Racine.

Sen. Alberta Darling, R-River Hills, also had concerns that Wisconsin was starting its own government insurance company under the bill. She added though there is no cost to the state initially, the cost to the government will inevitably increase.

“What you’re saying is we’re hoping for going off this and onto the Core program, but that will cost the government more and continue to jack up the cost for everybody else not on a government subsidy or government program,” Darling said.

However, supporters of the bill, including Sen. Judith Robson, D-Beloit, assured this is not a government-run insurance program because subsidies and premiums are going to pay for the entire program with no part of it being subsidized by taxpayers.

She added this is a transition and temporary program for people on the waiting list for the Core plan.

“It’s 25,000 people (on the waiting list); it’s a tsunami of people who have no health insurance. … I just can’t let those folks that are opposed to having the uninsured have health insurance and have basic care, it’s not the best, but it at least gives them some options,” Robson said.